Congenital heart disease (CHD) is the most common category of birth defect, affecting
1% of the population and requiring cardiovascular surgery in the first months of life
in many patients. Due to advances in congenital cardiovascular surgery and patient
management, most children with CHD now survive into adulthood. However, residual
and postoperative defects are common resulting in abnormal hemodynamics, which
may interact further with scar formation related to surgical procedures. Cardiovascular
magnetic resonance (CMR) has become an important diagnostic imaging modality in
the long-term management of CHD patients. It is the gold standard technique to assess
ventricular volumes and systolic function. Besides this, advanced CMR techniques allow
the acquisition of more detailed information about myocardial architecture, ventricular
mechanics, and fibrosis. The left ventricle (LV) and right ventricle have unique myocardial
architecture that underpins their mechanics; however, this becomes disorganized under
conditions of volume and pressure overload. CMR diffusion tensor imaging is able to
interrogate non-invasively the principal alignments of microstructures in the left ventricular
wall. Myocardial tissue tagging (displacement encoding using stimulated echoes) and
feature tracking are CMR techniques that can be used to examine the deformation and
strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting
motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1
mapping can help in detecting fibrotic myocardial changes and evolve our understanding
of the pathophysiology of CHD patients. This review not only gives an overview about
available or emerging CMR techniques for assessing myocardial mechanics and fibrosis
but it also describes their clinical value and how they can be used to detect abnormalities
in myocardial architecture and mechanics in CHD patients.